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A View on the report published by the Chief Medical Officer in December 2001

This is the first published national strategy against infectious disease, and is of great interest to those working in the field of infectious disease diagnosis and prevention. There is an excellent summary published in the CDR Weekly, 10th January, and so there is no need to repeat that work here. A few thoughts from the point of view of a supplier to the Public Health Laboratory Service (which stands to lose control of the majority of the laboratories currently part of its network0, to clinical microbiology laboratories which are part of NHS Trust pathology departments and to the very few independently controlled clinical laboratories that provide services to hospitals, clinics and general practice, may be of interest to some, however.

Action proposed within the report includes the establishment of a new agency, the National Infection Control and Health Protection Agency (NICHPA). This will subsume the PHLS, the Centre for Applied Microbiology and Research (CAMAR), the National Radiological Protection Board (NRPB) and the National Focus for Chemical Incidents (NFCI). It is interesting to ponder how much influence September 11th had on the timing and content of the report, although not much is discussed about biological or chemical terrorism hazards.

The removal of many laboratories from the PHLS is proposed as a means of achieving more even coverage and reporting of infectious diseases throughout the country, by placing the obligation on all NHS Trusts. At present the PHLS network reports in detail, as do some NHS Trust laboratories, but in others it is less comprehensive or consistent. A clear categorisation of microbiology laboratories into those providing routine diagnostic work and those providing reference, specialist or public health functions is intended. Diagnostic laboratories will have to work to common reference standards and standard operating procedures (SOP’s).

As a supplier, we have often seen laboratories forced to adopt methods or techniques on the grounds of “standardisation”. Although there are accepted arguments in favour of this, such as the increased mobility of the workforce, reduced training costs and better comparability of results between laboratories, it can sometimes be taken beyond this to standardisation for its own sake, and ignore the differing circumstance and needs of laboratories according to their workload, skill mix and relationships from other departments. It can also act as a barrier to innovation, as any variation to an SOP to exploit new technologies, e.g. new culture media formulations, must be approved for general use before being adopted.

A most significant gain to some NHS hospital pathology departments could be the integration of microbiology with the other disciplines. Although much of the work is technically very different, there are routine serology assays that can be performed on analysers that can also perform immunochemistry and some haemostasis tests. It is by no means guaranteed that this would occur, however, as the demarcation between disciplines is often very clear even between non-PHL microbiology and the other sections of hospital pathology departments.

Together with the major changes to come through the Modernising Pathology programme, these proposals seem set to effect huge changes on the shape of clinical microbiology in England.